| NPI | 1528427218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108717) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA9108717) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-08-08 |