NPI | 1174617773 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 264922-3102) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 264922-3102) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2007-10-04 |