| NPI | 1689002479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60870692) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.00477) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2018-07-30 |