| NPI | 1770735292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: OR PA161723) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NC 0010-01511) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2015-08-17 |