| NPI | 1063724458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61085406) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10808) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA61085406) | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2020-11-03 |