| NPI | 1124718747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA223351) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2025-07-16 |