| NPI | 1235565128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other (Licence: ID EE-285937) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: ID PA-1613) |
| 363AS0400X Physician Assistant Surgical (Licence: OR PA165087) | |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2024-09-30 |