| NPI | 1336629054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA213274) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: ID PA-2023) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2023-12-06 |