| NPI | 1912419276 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA55025) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: CA 55025) |
| 363A00000X Physician Assistant (Licence: CA PA55025) | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2018-03-17 |