| NPI | 1790780401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA152812) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 104119) |
| 363AS0400X Physician Assistant, Surgical (Licence: OR 152812) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2021-03-11 |