| NPI | 1548549199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2020015335) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA 60241973) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2022-02-23 |