NPI | 1114526720 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0006666) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2020-10-23 |
Last Update Date | 2021-07-16 |