| NPI | 1053077867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA207376) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: OR PA207376) |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2022-04-26 |