| NPI | 1164551289 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 197457) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0003955) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-04-10 |