| NPI | 1205991916 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA182393) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 1458) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2020-07-09 |