| NPI | 1215014584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA165390) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA165390) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-01-13 |