| NPI | 1649562679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA165170) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-02887) |
| 363A00000X Physician Assistant (Licence: NV PA1269) | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2020-09-24 |