| NPI | 1013419464 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9111072) | 
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 13896238-1206) | 
| Enumeration Date | 2018-03-01 | 
| Last Update Date | 2025-05-28 |