| NPI | 1336147768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 102812) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9101135) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2012-12-05 |