| NPI | 1023351814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA169409) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA169409) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2020-12-18 |