NPI | 1104100676 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1444) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1444) |
363AS0400X Physician Assistant, Surgical (Licence: ID PA-1444) | |
Enumeration Date | 2011-10-03 |
Last Update Date | 2023-12-22 |