NPI | 1245674944 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: LA PA.200613) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA09920) |
363A00000X Physician Assistant (Licence: LA PA.200613) | |
363AS0400X Physician Assistant Surgical | |
Enumeration Date | 2013-04-24 |
Last Update Date | 2021-03-30 |