| NPI | 1912665605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA221219) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 8812) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2024-10-01 |