| NPI | 1992475586 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010301) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA60055) |
| 363A00000X Physician Assistant (Licence: AZ 11144) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA60055) | |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2025-07-31 |