| NPI | 1760164131 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9865) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 63233) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2024-08-15 |