NPI | 1568799054 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA150467) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA150467) |
363AS0400X Physician Assistant, Surgical (Licence: WA PA60120088) | |
Enumeration Date | 2009-11-04 |
Last Update Date | 2024-10-01 |