| NPI | 1053941625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9112958) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical (Licence: FL PA9112958) | |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2024-06-03 |