| NPI | 1740665694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA225917) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA.PA.70013922) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2025-12-04 |