| NPI | 1730967902 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0136000269) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: 140639) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-09-19 |