| NPI | 1255713608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3513) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 351323) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2025-06-10 |