| NPI | 1174617252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102906) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NC 102906) |
| 363AS0400X Physician Assistant Surgical (Licence: VA 0110001648) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-01-15 |