| NPI | 1528077930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01455) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2026) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-03-27 |