| NPI | 1811088685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 008027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 784) |
| 363AS0400X Physician Assistant Surgical (Licence: MA PA784) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-04-14 |