| NPI | 1073779609 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59342) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2639) |
| 363A00000X Physician Assistant (Licence: CT 002128) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2021-05-04 |