| NPI | 1669112165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0136000573) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: 205973) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2022-03-31 |