| NPI | 1205478450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7650) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 57510) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 7650) | |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2025-10-22 |