| NPI | 1770835415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA173023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055740) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 3100-23) | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2021-12-28 |