| NPI | 1639381700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL 9112240) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA MA050662) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2025-11-03 |