| NPI | 1124029939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA00860) |
| 363A00000X Physician Assistant (Licence: ID PA-400) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2011-07-14 |