| NPI | 1265685762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61529253) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-780) |
| 363A00000X Physician Assistant (Licence: ID PA-780) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2024-05-02 |