| NPI | 1639708118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA065281) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-01-25 |