| NPI | 1184680167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051828) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA051828) |
| 363A00000X Physician Assistant (Licence: CA PA18658) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA18658) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA18658) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-07-28 |