| NPI | 1306353420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115665) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA55001) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 55001) | |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2022-07-11 |