| NPI | 1740684406 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 54599) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NE 1859) |
| 363AS0400X Physician Assistant Surgical (Licence: NE 1859) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2018-05-15 |