| NPI | 1417958794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9101956) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101956) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-03-11 |