| NPI | 1235412503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 51673) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003678) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110003678) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110003678) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 51673) | |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2014-12-15 |