| NPI | 1215711189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61604716) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2024-10-22 |