| NPI | 1447800701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL 9112462) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9112462) |
| 363AM0700X Physician Assistant Medical (Licence: FL 9112462) | |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2020-10-28 |