| NPI | 1922301522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA22312) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NH 0840) |
| 363AM0700X Physician Assistant Medical (Licence: CA PA22312) | |
| 363AS0400X Physician Assistant Surgical (Licence: NH 0840) | |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2012-09-04 |