| NPI | 1770815755 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119844) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: HI AMD-1144) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2025-07-02 |