| NPI | 1093223315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12363960-1206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60822151) |
| Enumeration Date | 2018-01-21 |
| Last Update Date | 2021-10-18 |