| NPI | 1962779033 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: VA 0110007649) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: PA MA055218) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2022-01-20 |