| NPI | 1164998613 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA218923) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2018-0069) |
| 363A00000X Physician Assistant (Licence: ME PA2506) | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2024-01-31 |