NPI | 1063412112 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MN 10090) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WI 1500-23) |
Enumeration Date | 2005-07-29 |
Last Update Date | 2015-06-30 |