| NPI | 1780213553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2021009905) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085008403) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2025-05-07 |