| NPI | 1174192561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114093) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA59630) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-04-09 |