| NPI | 1609111624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA51449) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 0162631) |
| 363A00000X Physician Assistant (Licence: CA PA51449) | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2014-06-13 |