| NPI | 1336338441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA150314) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-712) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2009-11-25 |