| NPI | 1932617651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA059669) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9113368) |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2020-12-14 |