| NPI | 1558739052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA53064) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP9003515) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-12-14 |