| NPI | 1578936092 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KS 1503041) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PAC9109288) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2025-02-10 |