| NPI | 1689244881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: 9117039) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110008168) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-03-18 |