| NPI | 1902340987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID 1504) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 54086) |
| Enumeration Date | 2016-12-11 |
| Last Update Date | 2021-12-14 |