| NPI | 1740302413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53220) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23011812) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-06-10 |