NPI | 1134609043 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA 58616) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA189997) |
Enumeration Date | 2018-08-20 |
Last Update Date | 2020-12-04 |