| NPI | 1740055979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA065216) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA065216) |
| 363A00000X Physician Assistant (Licence: PA MA065216) | |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2023-11-17 |