| NPI | 1982930798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 60107206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005184) |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2021-06-16 |