| NPI | 1558096313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C09140) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 5857) |
| Enumeration Date | 2022-07-17 |
| Last Update Date | 2023-12-04 |