NPI | 1326390030 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002779) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA4539) |
Enumeration Date | 2012-10-04 |
Last Update Date | 2014-07-11 |