| NPI | 1154706646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60987874) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ME PA1556) |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2021-05-03 |