| NPI | 1619181179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA60000908) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MA 2236) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-07-24 |