| NPI | 1730278037 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60511027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10200) |
| 363AM0700X Physician Assistant, Medical (Licence: ME PA1356) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-03-03 |