| NPI | 1588297675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: VA 0136000087) |
| Enumeration Date | 2020-02-17 |
| Last Update Date | 2021-06-11 |