| NPI | 1003196940 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 21661) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4240) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2014-02-25 |