NPI | 1619431384 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9112004) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL 9112004) |
Enumeration Date | 2019-01-28 |
Last Update Date | 2019-01-28 |