| NPI | 1508582933 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116656) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL PA9116656) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9116656) | |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2023-08-09 |