| NPI | 1740827377 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA196871) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR 196871) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2022-05-23 |