NPI | 1588033419 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109035) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109035) |
Enumeration Date | 2015-09-22 |
Last Update Date | 2022-11-23 |