| NPI | 1639273204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 102205) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA13334) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2015-11-16 |