| NPI | 1629378641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA 60404079) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 014421) |
| 363A00000X Physician Assistant (Licence: TX PA07611) | |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2013-12-27 |