NPI | 1053077867 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA207376) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA207376) |
Enumeration Date | 2021-11-16 |
Last Update Date | 2022-04-26 |