NPI | 1083640817 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA1069) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1069) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2010-11-22 |