| NPI | 1801178215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA180742) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2359) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2020-04-22 |