| NPI | 1811662588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID PA-2505) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 59865) |
| 363A00000X Physician Assistant (Licence: WA PA61191213) | |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-08-07 |