NPI | 1275018962 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 004281) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 004281) |
363AM0700X Physician Assistant, Medical (Licence: CT 004281) | |
Enumeration Date | 2018-09-27 |
Last Update Date | 2018-11-05 |