| NPI | 1619286481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105490) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9105490) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2021-12-03 |