| NPI | 1962927137 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61003199) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008302) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2020-01-24 |