| NPI | 1760064349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA64488) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-2599) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA062311) | |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2024-07-08 |