| NPI | 1255499455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NC 0010-07687) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103373) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-12-01 |