| NPI | 1720692395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA062448) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA062448) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2024-04-01 |