| NPI | 1912928334 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0000129) | 
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0002826) | 
| Enumeration Date | 2006-07-21 | 
| Last Update Date | 2018-04-03 |