| NPI | 1417324344 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA 54130) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3407) |
| 363AS0400X Physician Assistant Surgical (Licence: CT 3407) | |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2017-02-24 |