NPI | 1003479361 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9336) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 9336) |
363AM0700X Physician Assistant, Medical (Licence: GA 9336) | |
Enumeration Date | 2019-04-22 |
Last Update Date | 2025-07-01 |