| NPI | 1679199913 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9118791) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 4935) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-04-10 |