NPI | 1366085482 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9112586) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112586) |
363AS0400X Physician Assistant, Surgical (Licence: FL PA9112586) | |
Enumeration Date | 2019-10-21 |
Last Update Date | 2019-10-21 |