| NPI | 1568846046 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA53305) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 9383625-1206) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2019-02-11 |