| NPI | 1649570797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22778) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055-0031078) |
| 363A00000X Physician Assistant (Licence: NY 014227-1) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2014-09-22 |