| NPI | 1174891311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA161327) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA161327) |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 6287) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2019-07-03 |