| NPI | 1841268505 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60217463)  | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA166690)  | 
| 363A00000X Physician Assistant (Licence: MN 10257)  | |
| 363A00000X Physician Assistant (Licence: CO 2082)  | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2006-03-09 | 
| Last Update Date | 2022-04-20 |