NPI | 1669780847 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA055285) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055285) |
363AS0400X Physician Assistant, Surgical (Licence: NY 014360) | |
Enumeration Date | 2010-09-21 |
Last Update Date | 2022-03-04 |