| NPI | 1689903403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 347101-8906) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 16414) |
| 363A00000X Physician Assistant (Licence: WA PA 10003765) | |
| 363A00000X Physician Assistant (Licence: ID PA 752) | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2023-03-07 |