| NPI | 1962957662 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058288) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: PA MA058288) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2020-10-08 |