| NPI | 1427099480 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2011041741) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0002511) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2019-05-01 |