| NPI | 1912607110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12500) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 11500) |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2026-08-06 |