| NPI | 1790011260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA.60717760) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-364) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2022-07-21 |