| NPI | 1093797250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61092965) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61092965) |
| 363A00000X Physician Assistant (Licence: WI 1164-023) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 1164-023) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA 56266) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2020-12-18 |