| NPI | 1750992251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61301469) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13794) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2023-07-17 |