| NPI | 1043652142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114592) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60630951) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2021-10-05 |