| NPI | 1851650345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05099) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 22119) |
| 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-126763) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2023-05-15 |