| NPI | 1306110028 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2122) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA157072) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2021-11-01 |