| NPI | 1174263537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61566087) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA65155) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-04-30 |