| NPI | 1902452428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062247) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008282) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2023-12-04 |