| NPI | 1457667891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA178932) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2020025684) |
| 363A00000X Physician Assistant (Licence: IL 085008245) | |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2021-07-06 |