| NPI | 1811140080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA150706) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TN 1634) |
| 363AM0700X Physician Assistant Medical (Licence: OR PA150706) | |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2021-02-18 |