| NPI | 1154915197 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9633) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA210788) | 
| Enumeration Date | 2021-02-20 | 
| Last Update Date | 2025-06-02 |