| NPI | 1679122394 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59698) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.006190) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2021-08-16 |