| NPI | 1962978593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA201930) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 56165) |
| 207Q00000X Family Medicine (Licence: OR PA201930) | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2022-07-12 |