| NPI | 1770346835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID 8061671) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA065365) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA065365) | |
| Enumeration Date | 2024-02-01 |
| Last Update Date | 2024-09-03 |