| NPI | 1104003623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 107170) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WI 29008-031) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2008-01-28 |