NPI | 1710302831 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA 60421675) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 56888) |
363A00000X Physician Assistant (Licence: UT 12886344-1206) | |
Enumeration Date | 2014-02-26 |
Last Update Date | 2025-01-26 |