| NPI | 1225149685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2012037436) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA WA PA 10004933) |
| 363A00000X Physician Assistant (Licence: MN 11042) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2017-03-15 |