| NPI | 1043564701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA165483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055837) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2019-01-23 |