| NPI | 1528734597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA062627) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA062627) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2021-10-06 |