| NPI | 1760551568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-01257) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NC 8092) |
| 363AS0400X Physician Assistant, Surgical (Licence: SC 772) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2010-07-26 |