NPI | 1134540941 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61230443) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA0275) |
Enumeration Date | 2013-12-20 |
Last Update Date | 2025-05-21 |