| NPI | 1184996555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA164906) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA164906) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2020-12-18 |