| NPI | 1912398397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 57658) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: HI AMD596) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2020-04-14 |