| NPI | 1881634327 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9102648) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA9102648) |
| 363AS0400X Physician Assistant Surgical (Licence: TX PA02505) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-03-05 |