| NPI | 1679123111 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 57222) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2023-10-23 |