| NPI | 1972842326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 1075) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AK 1075) |
| 363AM0700X Physician Assistant, Medical (Licence: AK 1075) | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2014-02-12 |