| NPI | 1770766842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA22250) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22250) |
| 363A00000X Physician Assistant (Licence: SC TL1276) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105317) | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2020-02-26 |