NPI | 1265116321 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA17563) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA17563) |
363A00000X Physician Assistant (Licence: MI 5601011798) | |
Enumeration Date | 2023-06-09 |
Last Update Date | 2024-06-02 |