| NPI | 1962485060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11429) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 559416) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA18002) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-10-24 |