| NPI | 1548510696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA186509) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200824) |
| 363A00000X Physician Assistant (Licence: OR PA186509) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2020-12-22 |