| NPI | 1023049905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA100004253) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 10125) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2016-01-25 |