| NPI | 1619379062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60504943) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1458) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2021-08-18 |