| NPI | 1740251644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56241) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1148) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2019-01-04 |