| NPI | 1164987251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NC 245463) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 245463) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2024-06-19 |