| NPI | 1740053222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WV 2819) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WV 875) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-12-01 |