| NPI | 1912373317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60943083) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA031168) |
| 363A00000X Physician Assistant (Licence: CA 54396) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2022-05-10 |