| NPI | 1972501930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 62382) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50002107) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2023-12-15 |