| NPI | 1154451664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA11455) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA11455) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA11455) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-10-05 |