| NPI | 1902815004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA 60115633) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103337) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2012-05-02 |