| NPI | 1104280940 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60731572) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 2877) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2020-11-20 |