NPI | 1083880850 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3722) |
Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 004830) |
Enumeration Date | 2008-05-01 |
Last Update Date | 2021-07-26 |