| NPI | 1508414012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60677) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 11433416-1206) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2022-05-26 |