| NPI | 1003394891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 308907) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA PA.308907) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2021-08-24 |