| NPI | 1992070452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 2123) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN 2123) |
| 363A00000X Physician Assistant (Licence: TN 2123) | |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2014-05-09 |