| NPI | 1952730608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60788185) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-1116) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2021-04-14 |