| NPI | 1164629580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA169442) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-04-08 |