NPI | 1639403041 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-820) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-820) |
363A00000X Physician Assistant (Licence: UT 12409905-1206) | |
Enumeration Date | 2009-10-01 |
Last Update Date | 2022-04-27 |