| NPI | 1558434159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 62616) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 102542) |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-06-06 |