| NPI | 1043606155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60892408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-004918) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2018-12-13 |