| NPI | 1710491386 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110803) |
| Enumeration Date | 2017-11-19 |
| Last Update Date | 2021-06-03 |