NPI | 1568928950 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9119550) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9112041) |
363AS0400X Physician Assistant, Surgical (Licence: TN 4326) | |
Enumeration Date | 2019-02-11 |
Last Update Date | 2025-02-19 |