| NPI | 1174118558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61603088) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5486) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2025-07-14 |