| NPI | 1780934091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA170371) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03780) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2023-03-07 |