| NPI | 1679969620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5302) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA5302) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2022-07-25 |