| NPI | 1962965970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C08479) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601012798) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 025209) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-01-23 |