| NPI | 1609439983 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA214103) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 4651) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2023-04-20 |