| NPI | 1114274669 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10125) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60619751) |
| 363A00000X Physician Assistant (Licence: NY 015800-1) | |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2024-02-08 |