| NPI | 1760991509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR PA185216) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA185216) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2025-04-03 |