| NPI | 1952814873 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MA PA6325) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MA PA6325) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2019-08-19 |