| NPI | 1194487157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9115147) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL 9115147) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2023-01-19 |