NPI | 1255772976 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 3569) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 016633) |
Enumeration Date | 2013-07-10 |
Last Update Date | 2018-02-14 |