| NPI | 1427503721 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1408) | 
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 4883) | 
| Enumeration Date | 2016-08-17 | 
| Last Update Date | 2023-07-03 |