| NPI | 1467995530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA189566) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2016-0100) |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2019-02-08 |