| NPI | 1255633657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA 189763) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4029) |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2024-12-03 |