| NPI | 1376106823 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9114070) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 1-Pending) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2026-02-09 |