NPI | 1972257673 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9120424) |
Enumeration Date | 2022-02-10 |
Last Update Date | 2025-09-15 |