| NPI | 1205893666 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 22143) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1523) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2012-10-04 |