| NPI | 1932405479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA059320) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003490) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2017-11-08 |