| NPI | 1104027788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60972342) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C02617) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2019-09-12 |