| NPI | 1659054013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2026-02-18 |