| NPI | 1962472506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 7797) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA003457L) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 3714) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2017-04-21 |