| NPI | 1750038576 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0137000613) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: 207959) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-03-02 |