| NPI | 1013990860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WA PA61541738) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CO 3400) |
| 363AM0700X Physician Assistant Medical (Licence: MI 5601004399) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2024-07-02 |