| NPI | 1356391973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL pa9102922) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY PA2201) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-08-04 |