| NPI | 1689456881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-13816) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-13816) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9117986) | |
| Enumeration Date | 2023-10-20 |
| Last Update Date | 2024-07-31 |