| NPI | 1972610020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104283) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104283) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2011-08-12 |