| NPI | 1164992574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA61243234) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023038-1) |
| 363A00000X Physician Assistant (Licence: WA PA61243234) | |
| 363AM0700X Physician Assistant Medical (Licence: NY 023038-1) | |
| 363AS0400X Physician Assistant Surgical (Licence: NY 023038-1) | |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2022-05-02 |