NPI | 1053941625 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9112958) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical (Licence: FL PA9112958) | |
Enumeration Date | 2020-01-22 |
Last Update Date | 2024-06-03 |