NPI | 1003420795 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA221668) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA 61328609) |
Enumeration Date | 2020-09-01 |
Last Update Date | 2024-10-01 |