| NPI | 1679681035 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA156252) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103873) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2025-12-16 |