| NPI | 1689457830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA218183) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-03-04 |