| NPI | 1972785814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA160669) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002013) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2021-02-15 |