| NPI | 1841567674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60711668) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1099) |
| 363A00000X Physician Assistant (Licence: AZ 5055) | |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 5055) | |
| 363AS0400X Physician Assistant, Surgical (Licence: AL 1099) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2023-10-20 |