| NPI | 1730074980 |
|---|---|
| Professional Name | NA NA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA223922) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00917400) |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-08-26 |