| NPI | 1114284759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 012193) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53211) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2025-03-07 |