| NPI | 1023091618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA01044) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AK 2087) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2022-10-06 |