| NPI | 1205358157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 344737) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 020962) |
| 363A00000X Physician Assistant (Licence: CO PA.0006207) | |
| 363A00000X Physician Assistant (Licence: TX PA15333) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-01-02 |