| NPI | 1952775520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR PA174318) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA60593873) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |