| NPI | 1144611971 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA201988) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60613313) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110006164) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108211) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2021-02-18 |