| NPI | 1265678163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD464) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60062946) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60062946) | |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2015-01-09 |