| NPI | 1073849238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PENDING- TEMPORARY) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PENDING - TEMPORARY) |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2009-10-22 |