| NPI | 1336717560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA60089) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114146) |
| 363AM0700X Physician Assistant Medical (Licence: FL PA9114146) | |
| 363AM0700X Physician Assistant Medical (Licence: CA PA60089) | |
| 363AS0400X Physician Assistant Surgical (Licence: CA PA60089) | |
| 363AS0400X Physician Assistant Surgical (Licence: FL PA9114146) | |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2022-05-03 |