| NPI | 1972939007 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53541) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 016989-1) |
| 363AS0400X Physician Assistant Surgical (Licence: NY 016989-1) | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2016-08-04 |