| NPI | 1083169890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA058639) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA058639) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2024-01-26 |