| NPI | 1164559415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA833) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NV PA833) |
| 363AM0700X Physician Assistant Medical (Licence: FL PA9114559) | |
| 363AS0400X Physician Assistant Surgical (Licence: NV PA833) | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-08-31 |