| NPI | 1083949408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 0004623) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013500) |
| 363A00000X Physician Assistant (Licence: OH 50.004122) | |
| Enumeration Date | 2009-10-04 |
| Last Update Date | 2016-10-20 |