| NPI | 1154192334 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA100730) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA63922) |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2024-08-23 |