| NPI | 1376165134 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA214407) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA7898) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2023-06-08 |