| NPI | 1174961288 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA1587) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA60375274) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2021-08-25 |