| NPI | 1184914608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA153752) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OR PA 153-752) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2020-09-23 |