| NPI | 1699122390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14058) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53869) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2024-09-27 |