| NPI | 1568799054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA150467) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA150467) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60120088) | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2024-10-01 |