| NPI | 1164058277 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 61077701) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-1969) |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2023-01-12 |