| NPI | 1831453109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60970121) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1358) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60970121) | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2020-12-02 |