| NPI | 1629840566 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61563108) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9118088) |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2024-09-24 |