| NPI | 1457449316 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102981) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9102981) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-11-06 |