| NPI | 1821223553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108732) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2405) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL 9108732) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 002379) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 15604) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2021-06-03 |