| NPI | 1245507219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA163865) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA163865) |
| 363AM0700X Physician Assistant, Medical (Licence: AK 2164) | |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2023-03-07 |