| NPI | 1043612674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA060643) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05567) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2019-10-30 |