| NPI | 1750985305 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114813) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61421656) |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2023-08-01 |