| NPI | 1629480207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 106268) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD CO5329) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2022-09-01 |