| NPI | 1972018513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GU PA115) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA55197) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2018-08-23 |