| NPI | 1770264954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0008995) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110009367) |
| 363A00000X Physician Assistant (Licence: MD C0008995) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110009367) | |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2023-07-31 |