| NPI | 1295071496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA160191) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA1233) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2019-03-21 |