NPI | 1508859968 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA218220) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NM PA2005-0004) |
Enumeration Date | 2005-08-31 |
Last Update Date | 2025-07-09 |