| NPI | 1538649736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59160) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 022457) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 5922) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2025-08-26 |