| NPI | 1215358973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60901077) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 23.003034) |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2021-05-06 |