| NPI | 1962093419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT MED-PAC-LIC-125420) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA061920) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2023-06-15 |