| NPI | 1780059204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4390) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 4390) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-12218) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-005152) | |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2025-10-20 |