| NPI | 1972861458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057745) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4377) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2021-03-04 |