| NPI | 1225556574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 54727) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005530) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2022-11-17 |