| NPI | 1548512619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC PA2723) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 22879) |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: MD C04906) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2019-12-18 |