| NPI | 1164824256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 0005414) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA179191) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60706338) | |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2019-10-21 |