| NPI | 1194122002 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60644257) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005626) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2016-12-08 |