| NPI | 1083755607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA155946) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-03-07 |