NPI | 1235485319 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106495) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106495-PAX9356) |
Enumeration Date | 2012-07-26 |
Last Update Date | 2022-07-21 |