| NPI | 1790004844 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA60511351) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60511351) |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60511351) | |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2021-07-30 |