| NPI | 1417943358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA195363) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 1243) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2020-01-23 |