| NPI | 1578234803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9114951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 1578234803) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-10-06 |