| NPI | 1073983490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA183923) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05997) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2019-01-04 |