| NPI | 1700411675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 4139) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9112879) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2023-11-01 |