| NPI | 1982031910 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 079216) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5578) |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 5578) | |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2021-09-21 |