| NPI | 1538610696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: PA MA058618) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2022-06-13 |