| NPI | 1194703652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA22228) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018361) |
| 363AM0700X Physician Assistant Medical (Licence: CO 868) | |
| 363AM0700X Physician Assistant Medical (Licence: AK 638) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2015-01-12 |