NPI | 1619165354 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 003285) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003498) |
363AS0400X Physician Assistant, Surgical (Licence: NY 245256) | |
Enumeration Date | 2007-10-09 |
Last Update Date | 2011-09-15 |