| NPI | 1912458753 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA55988) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06779) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-06779) | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2023-08-02 |