| NPI | 1417646464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN PA5515) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA0000005515) |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2023-09-08 |