| NPI | 1831570449 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6569) |
| Additional Taxonomies | 2088P0231X Urology Pediatric Urology (Licence: CA 54131) |
| 363A00000X Physician Assistant (Licence: CA PA54131) | |
| 363AM0700X Physician Assistant Medical (Licence: MD MDC0005732) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2018-09-12 |