| NPI | 1184510687 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1041618) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110001433) |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-06-24 |