| NPI | 1972882405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10031) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA175950) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2023-03-27 |