| NPI | 1336123447 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR PA219051) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9469) |
| 363A00000X Physician Assistant (Licence: OR PA219051) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2024-03-27 |