| NPI | 1992070874 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA162371) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA162371) |
| 363A00000X Physician Assistant (Licence: CA PA22177) | |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2022-02-11 |