| NPI | 1629354055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA.PA.61305180) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106908) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 57209) | |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2025-07-09 |