| NPI | 1154950954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC PA4530) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA7632) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA7632) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-11-04 |