| NPI | 1164709630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 8139778-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA52245) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA52245) | |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2019-06-19 |