| NPI | 1043540701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60820921) | |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA1330) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60820921) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2021-03-19 |