| NPI | 1164941456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 61135925) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 58905) |
| 363A00000X Physician Assistant (Licence: MI 5601008391) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2023-09-07 |