| NPI | 1508535485 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA63433) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9114268) |
| 363A00000X Physician Assistant (Licence: NY 027012) | |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2023-10-12 |