| NPI | 1720312184 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR PA150291) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA150291) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2024-05-22 |