| NPI | 1780159541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA226711) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 3075) |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2025-08-22 |