| NPI | 1942290804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 6526009-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 007859-1) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2018-03-17 |