| NPI | 1487697827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID 058) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004766) |
| 363A00000X Physician Assistant (Licence: MT 506) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-02-03 |