| NPI | 1972960250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12294) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60637513) |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60637513) | |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2019-01-17 |