| NPI | 1487922191 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA 301719) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA4292) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2019-08-22 |