| NPI | 1356992762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61151928) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA 61151928) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2024-11-16 |