| NPI | 1740681311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA173787) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2017-0002) |
| Enumeration Date | 2014-09-14 |
| Last Update Date | 2021-08-17 |