| NPI | 1730633868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR OMBPA179664) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA179664) |
| 363A00000X Physician Assistant (Licence: OR OMBPA179664) | |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2021-01-15 |