| NPI | 1053742197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 6858) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA51377) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2022-01-19 |