| NPI | 1871850883 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA22196) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015574) |
| Enumeration Date | 2012-04-15 |
| Last Update Date | 2017-12-04 |