| NPI | 1851406011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8599800-1206) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 20419) |
| 363A00000X Physician Assistant (Licence: NC 0010-00485) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO 2516) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-03-18 |