| NPI | 1245547330 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA164609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2651) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2016-07-26 |