| NPI | 1659688604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105618) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105618) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2010-10-13 |