| NPI | 1114763612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14456) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA66349) |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2025-07-11 |