| NPI | 1417036351 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002417) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030462) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C03941) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2016-04-05 |