| NPI | 1215177852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA192533) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NH 0709) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2024-06-17 |