| NPI | 1477865129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 5648676-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-906) |
| 363A00000X Physician Assistant (Licence: CA 21017) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2020-09-23 |