| NPI | 1104805001 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA380) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA3280) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2018-03-17 |