| NPI | 1548623481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60602146) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007684) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |