| NPI | 1568090918 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2021012355) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4609) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 4609) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-01-04 |