| NPI | 1639239494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61047107) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009339) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-09-01 |