| NPI | 1538398441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9109794) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01846) |
| 363AS0400X Physician Assistant Surgical (Licence: TN 1834) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2019-02-12 |