| NPI | 1760788970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108064) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV 1096273) |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2015-02-16 |