| NPI | 1275539884 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA100004734) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2015-10-09 |