| NPI | 1811521420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2020006082) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2022-05-20 |