| NPI | 1629123302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01211) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 469) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2017-11-03 |