| NPI | 1720675291 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008599) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 1174480) |
| 363AS0400X Physician Assistant, Surgical (Licence: ME PA2179) | |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2022-06-07 |