| NPI | 1376935270 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA195237) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA195237) |
| 363AM0700X Physician Assistant, Medical (Licence: WA 6069635270) | |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2023-09-28 |