| NPI | 1811625437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA063843) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MA063843) |
| 208200000X Plastic Surgery (Licence: PA MA063843) | |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-11-05 |