| NPI | 1154306009 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61118921) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA 156420) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 010077) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2021-06-01 |