| NPI | 1083640817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA1069) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA1069) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2025-08-13 |