| NPI | 1063468148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 58106) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110840770) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-08-02 |