| NPI | 1609178623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA53478) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054626) |
| 363AM0700X Physician Assistant, Medical (Licence: AK 113251) | |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2017-01-06 |