| NPI | 1942843107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61139014) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA57278) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2021-09-30 |