| NPI | 1912398025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 56396) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA09245) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 85005641) | |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2024-03-27 |