| NPI | 1407412893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT MED-PAC-LIC-107382) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 107382) |
| 363A00000X Physician Assistant (Licence: MN 13288) | |
| 363A00000X Physician Assistant (Licence: WI 4979-23) | |
| Enumeration Date | 2019-05-12 |
| Last Update Date | 2026-06-26 |