NPI | 1356876403 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4535) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 9110267) |
Enumeration Date | 2017-04-26 |
Last Update Date | 2024-09-23 |