| NPI | 1609474428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 324688) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA 324688) |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2023-09-26 |