NPI | 1629404207 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C05196) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA168081) |
363A00000X Physician Assistant | |
363AM0700X Physician Assistant, Medical (Licence: MD C05196) | |
Enumeration Date | 2013-09-16 |
Last Update Date | 2022-10-19 |