| NPI | 1932808482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 7314) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN 5389) |
| 363A00000X Physician Assistant (Licence: TN 5389) | |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2024-09-13 |