| NPI | 1144543927 | 
|---|---|
| Former Name | WALDA LORA | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105378) | 
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105378) | 
| Enumeration Date | 2010-03-08 | 
| Last Update Date | 2023-01-11 |