| NPI | 1922745066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-11895) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 001011895) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2024-03-05 |