NPI | 1104255785 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60448342) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60448342) |
363AS0400X Physician Assistant, Surgical (Licence: WA PA60448342) | |
Enumeration Date | 2013-11-05 |
Last Update Date | 2021-10-04 |