| NPI | 1255920336 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062182) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA062182) |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2023-08-22 |