| NPI | 1104170489 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA176507) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA 60316612) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2017-02-28 |