| NPI | 1669515623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60874684) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA06311) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA 2053) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2021-04-22 |