| NPI | 1770050072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007865) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 12836) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2021-08-25 |