| NPI | 1548582455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3938) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MS pa00151) |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2011-07-20 |