| NPI | 1063200103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15510) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NC 0010-15510) |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-08-05 |