| NPI | 1629322607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN 2248) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TN 2248) |
| 363AM0700X Physician Assistant Medical (Licence: MS 179) | |
| 363AS0400X Physician Assistant Surgical (Licence: MS 179) | |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2021-09-10 |