| NPI | 1205238805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61131763) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA170090) |
| 363AS0400X Physician Assistant, Surgical (Licence: LA PA.200731) | |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2021-03-02 |