| NPI | 1902397219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58519) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11954) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2021-02-02 |