| NPI | 1497183123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107463) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PAT9107463) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2022-02-08 |