| NPI | 1649782699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA187398) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2019-09-10 |