| NPI | 1417508045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA201602) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61092040) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9112583) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2020-10-07 |