| NPI | 1801185988 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA153514) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OR PA153514) | 
| Enumeration Date | 2011-03-29 | 
| Last Update Date | 2025-08-20 |