| NPI | 1760985568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MA PA6506) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA6506) |
| Enumeration Date | 2018-03-18 |
| Last Update Date | 2020-03-15 |