| NPI | 1730602376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA57700) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 9110500) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL 9110500) | |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2020-07-15 |