NPI | 1407552722 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9117188) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9117188) |
Enumeration Date | 2023-02-07 |
Last Update Date | 2025-02-18 |