NPI | 1518213453 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106618) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106618) |
Enumeration Date | 2012-07-30 |
Last Update Date | 2025-07-10 |