| NPI | 1710071634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: VA 0110001685) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA 9104418) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-04-11 |