| NPI | 1356747042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1210) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA60494489) |
| 363A00000X Physician Assistant (Licence: WA PA60494489) | |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2017-02-16 |