| NPI | 1265178925 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61366379) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2650) |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2022-12-27 |