| NPI | 1861672909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00111) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MS 00111) |
| 363AS0400X Physician Assistant, Surgical (Licence: AL TA1635) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2018-09-13 |