| NPI | 1801148234 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056621) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CT 002842) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2020-10-16 |