NPI | 1740062991 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA223585) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA223585) |
Enumeration Date | 2023-10-20 |
Last Update Date | 2025-04-09 |