| NPI | 1912215377 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA196112) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 7756259-1206) |
| 363AS0400X Physician Assistant, Surgical (Licence: AK 2251) | |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2023-07-18 |