NPI | 1306313556 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA060304) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA OA004677) |
Enumeration Date | 2018-10-25 |
Last Update Date | 2018-10-25 |