| NPI | 1528660826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT MED-PAC-LIC-98855) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1178678) |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2021-12-14 |