| NPI | 1558499897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60625279) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1463) |
| 363AM0700X Physician Assistant, Medical (Licence: ID PA-1463) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 363AS0400X Physician Assistant, Surgical (Licence: OR PA01179) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60625279) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2023-04-18 |