| NPI | 1679203988 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA.PA.61479317) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: ID PA-2607) | |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2023-10-21 |