| NPI | 1114349693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 52673) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001004757) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-04757) | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2022-12-19 |