| NPI | 1306313556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA060304) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA OA004677) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2018-10-25 |