| NPI | 1700452117 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 107503) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 5437-23) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2022-11-16 |