| NPI | 1952685703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA pa.60767796) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6243) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2018-03-17 |