| NPI | 1871790725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 19540) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 11172710-1206) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2022-12-28 |