NPI | 1568943058 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00496000) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 022526-01) |
Enumeration Date | 2018-08-23 |
Last Update Date | 2024-09-19 |