| NPI | 1790731859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.781) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 15420) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2011-10-21 |