| NPI | 1821377920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54731) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110004371) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 016800) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2022-06-01 |