| NPI | 1619276789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109222) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109222) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2020-08-21 |