| NPI | 1306597802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9118808) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9118808) |
| Enumeration Date | 2022-01-16 |
| Last Update Date | 2025-01-31 |