| NPI | 1265497630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 257522-4568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA12256) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA 12256) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2011-11-01 |