| NPI | 1134540941 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61230443) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA0275) | 
| Enumeration Date | 2013-12-20 | 
| Last Update Date | 2025-05-21 |