| NPI | 1174979090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53459) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3567) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 3567) | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2021-05-27 |