| NPI | 1245826320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA221727) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 10145) |
| 363A00000X Physician Assistant (Licence: GA 10145) | |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2024-08-23 |