| NPI | 1356315808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004954) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-609) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2021-05-24 |