| NPI | 1508230533 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA192050) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057956) |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2020-09-29 |