| NPI | 1710291471 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO 09-0838) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2015-01-29 |