| NPI | 1538206875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01235) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 60709) |
| 363AS0400X Physician Assistant, Surgical (Licence: OR PA01235) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2024-04-01 |