| NPI | 1538410550 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54982) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 016061) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2019-08-02 |