| NPI | 1790056620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110007174) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD818) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2025-09-11 |