| NPI | 1871635094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 1200) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: GA 1200) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-06-24 |