| NPI | 1063958684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60705480) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.005988) |
| Enumeration Date | 2017-01-07 |
| Last Update Date | 2020-10-14 |