| NPI | 1962734004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106602) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 1090751) |
| Enumeration Date | 2010-01-30 |
| Last Update Date | 2014-10-21 |