| NPI | 1164690293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104492) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104492) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2021-10-23 |