| NPI | 1598031130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5091) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1338) |
| 363A00000X Physician Assistant (Licence: CA PA22149) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA22149) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2021-06-15 |