| NPI | 1912040049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004199) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004199) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2021-01-20 |