| NPI | 1902237167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-60845) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MT MED-PAC-LIC-60845) |
| 363AS0400X Physician Assistant, Surgical (Licence: WV 01774) | |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2026-01-21 |