| NPI | 1083924948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA00428) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OR PA00428) |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2013-06-14 |