| NPI | 1013028430 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MA 568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 568) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-08-02 |