| NPI | 1750568119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA053315) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60285496) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60285496) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2021-08-19 |