| NPI | 1568928950 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119550) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9112041) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 4326) | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2025-02-19 |