| NPI | 1750926127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10285) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61075482) |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2023-10-27 |