| NPI | 1578219762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA 60825) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 60825) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2022-10-19 |