| NPI | 1093279507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA213830) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6840) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2023-06-06 |