| NPI | 1629293790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 9103042) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA 9103042) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2011-10-21 |