| NPI | 1235753880 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61640106) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0006501) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2025-05-28 |