| NPI | 1215996905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA195784) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C01863) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2022-01-05 |