| NPI | 1255802583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59080) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 022364) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2021-08-19 |