| NPI | 1790085256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA156758) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA156758) |
| 363AM0700X Physician Assistant, Medical (Licence: WA BG60195546) | |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2022-11-30 |