NPI | 1013419464 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9111072) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 13896238-1206) |
Enumeration Date | 2018-03-01 |
Last Update Date | 2025-05-28 |