| NPI | 1609443589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR 214110) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA 60671) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2023-03-23 |