| NPI | 1164124616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119702) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 62504) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-05-11 |