| NPI | 1124420641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA196289) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 57817) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2021-08-04 |