NPI | 1104139153 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA054370) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054370) |
Enumeration Date | 2010-07-20 |
Last Update Date | 2013-08-16 |