NPI | 1033766860 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9117796) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 023879) |
Enumeration Date | 2019-08-26 |
Last Update Date | 2024-06-24 |