| NPI | 1194979690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60053259) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60053259) |
| 363AM0700X Physician Assistant, Medical (Licence: OR PA01272) | |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2022-03-11 |