| NPI | 1588968317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60270453) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003975) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2012-03-01 |