| NPI | 1538712641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60979645) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-10-09 |