| NPI | 1174901854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA179541) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA179541) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2020-10-13 |