| NPI | 1609112267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 22592) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA22592) |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2020-01-23 |