| NPI | 1639629579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112402) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9112402) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C06217) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2019-09-24 |