| NPI | 1861963761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111741) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9111741) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2021-12-14 |