NPI | 1639551468 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA202153) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA202153) |
363A00000X Physician Assistant (Licence: NM PA2015-0039) | |
Enumeration Date | 2015-06-29 |
Last Update Date | 2020-12-18 |