| NPI | 1730574260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA196435) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA196435) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2020-12-28 |