| NPI | 1679725139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 21556) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA AP2631) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA AP2631) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2022-11-03 |