| NPI | 1932658184 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61109266) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008589) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 084424) | |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2020-12-02 |