NPI | 1578814976 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 3029) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 3029) |
363A00000X Physician Assistant (Licence: WI 3029) | |
363AS0400X Physician Assistant, Surgical (Licence: IL 385003967) | |
Enumeration Date | 2012-09-25 |
Last Update Date | 2015-12-11 |