| NPI | 1972259497 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-11929) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11929) |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2022-12-16 |