| NPI | 1861654170 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 002278) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01398) |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 002278) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2009-04-21 |