| NPI | 1407618291 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA102227) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61516113) |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2026-01-28 |