| NPI | 1023631090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PACN38) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PR 2064-PA) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 14-518) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL TPPA669) | |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2025-05-06 |