| NPI | 1982905881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA187487) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5175) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-02569) | |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2018-04-20 |