NPI | 1598196974 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 100961-875) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5596) |
363A00000X Physician Assistant (Licence: CO PA.0003941) | |
363AS0400X Physician Assistant, Surgical (Licence: AZ 5596) | |
Enumeration Date | 2013-12-10 |
Last Update Date | 2025-04-15 |