| NPI | 1790861672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53870) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05696) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 011089) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2018-09-25 |