| NPI | 1629755020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA9495) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA9495) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2025-04-07 |