| NPI | 1770192759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WA PA61169528) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 1174414) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2024-02-02 |