| NPI | 1811573827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9114141) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL 9114141) |
| 363AM0700X Physician Assistant, Medical (Licence: FL 9114141) | |
| Enumeration Date | 2021-03-20 |
| Last Update Date | 2023-11-14 |