| NPI | 1306507751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA214862) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR 214862) |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2023-10-27 |