NPI | 1225389604 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5290) |
363AM0700X Physician Assistant Medical (Licence: AZ 5290) | |
363AS0400X Physician Assistant Surgical (Licence: AZ 5290) | |
Enumeration Date | 2012-09-26 |
Last Update Date | 2021-05-07 |