| NPI | 1053139477 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA065982) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA065982) |
| Enumeration Date | 2024-10-03 |
| Last Update Date | 2025-07-22 |