| NPI | 1679591648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA10005172) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011254) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-08-26 |