| NPI | 1679815302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA175460) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2023-05-17 |