NPI | 1336625623 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58863) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00487400) |
363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00487400) | |
Enumeration Date | 2018-07-19 |
Last Update Date | 2023-03-27 |