| NPI | 1255720025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA 52252) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52252) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2021-01-12 |