| NPI | 1023776630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063014) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: PA MA063014) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2022-02-14 |