| NPI | 1073936928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107781) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9107781) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2018-06-12 |