| NPI | 1508263716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60509719) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60509719) |
| 363AM0700X Physician Assistant Medical (Licence: WA PA60509719) | |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2017-01-31 |