| NPI | 1619165354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 003285) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003498) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 245256) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2011-09-15 |