| NPI | 1629590120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60987916) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6775) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 6775) | |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2021-01-18 |