| NPI | 1518096221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA-003205-L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA-000876) |
| 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0000397) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |