| NPI | 1790211985 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55704) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07160) |
| 363A00000X Physician Assistant (Licence: VA 0110-005813) | |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2020-05-14 |