| NPI | 1598324477 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9117684) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001323) |
| 363A00000X Physician Assistant (Licence: MO 2022013937) | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2024-06-16 |