| NPI | 1861961377 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA060078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004600) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA004600) | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2020-10-07 |