| NPI | 1770790602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA60225033) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004270) |
| 367H00000X Anesthesiologist Assistant (Licence: GA 004270) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-05-12 |