| NPI | 1356691125 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006199) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY P85602) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085.004960) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2020-04-13 |