| NPI | 1013059807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA01201) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA01201) |
| 363AS0400X Physician Assistant, Surgical (Licence: HI AMD 317) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2018-09-18 |