| NPI | 1679129902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9113268) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9113268) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2022-07-28 |