| NPI | 1639413321 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60316200) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0997) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2016-06-02 |