| NPI | 1417043597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5303) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004662) |
| 363A00000X Physician Assistant (Licence: IA 00001980) | |
| 363A00000X Physician Assistant (Licence: OR PA153806) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2014-10-22 |