NPI | 1164559415 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA833) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA833) |
363AM0700X Physician Assistant, Medical (Licence: FL PA9114559) | |
363AS0400X Physician Assistant, Surgical (Licence: NV PA833) | |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2007-02-27 |
Last Update Date | 2021-08-31 |