| NPI | 1154879351 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR 189587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA189587) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2025-09-10 |