| NPI | 1972726784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA19190) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9104116) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA19190) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-10-19 |