| NPI | 1689117657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9110070) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: FL AL 3279) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2023-04-12 |