| NPI | 1518056738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA17721) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-001779) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA17721) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2017-03-17 |