| NPI | 1528208196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA 60716553) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 002237) |
| 363A00000X Physician Assistant (Licence: CT 002237) | |
| 363AM0700X Physician Assistant, Medical (Licence: MA PA3969) | |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2021-05-12 |