| NPI | 1861865685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA202214) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA202214) |
| 363A00000X Physician Assistant (Licence: CA 52893) | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2022-11-18 |