| NPI | 1538241120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR 159864) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK PA201) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-11-09 |