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 |