| NPI | 1114579380 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 4528) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9318) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2022-11-10 |