| NPI | 1811662810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA063881) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9120925) |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2025-12-10 |