| NPI | 1811419682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR PA191043) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2019-01-03 |