| NPI | 1356694384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1213) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA159954) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2019-08-14 |