| NPI | 1164752515 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56459) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 013816) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2019-07-08 |