| NPI | 1407131733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA155246) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-955) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2025-01-02 |