| NPI | 1194380139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009677) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 024129) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9116332) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2024-02-20 |