NPI | 1295070654 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107005) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107005) |
Enumeration Date | 2012-12-11 |
Last Update Date | 2012-12-11 |