| NPI | 1700631751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0012064) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-15865) |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2025-10-03 |