| NPI | 1235582321 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9112194) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55159) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 019828) | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2019-10-08 |