| NPI | 1962891036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 84768) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA52159) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2022-04-05 |