| NPI | 1649722117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA OA004575) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058681) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2023-06-23 |