| NPI | 1629760319 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117660) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9117660) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-08-02 |