| NPI | 1235653288 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR pa203713) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12437) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2021-06-04 |