| NPI | 1871559252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 113768) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA3557) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2019-02-19 |