| NPI | 1760720866 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107045) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9107045) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2022-07-21 |