| NPI | 1245458660 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: GA 581945565) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2013-10-04 |