| NPI | 1316223779 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 69320) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA162738) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2021-02-07 |