NPI | 1568063196 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12719) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL 1754) |
Enumeration Date | 2020-11-02 |
Last Update Date | 2025-09-16 |