NPI | 1417429812 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 4632) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4632) |
363A00000X Physician Assistant (Licence: MN 12975) | |
Enumeration Date | 2018-12-23 |
Last Update Date | 2024-08-20 |