| NPI | 1982975512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 9107851) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 4947) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2016-04-25 |