NPI | 1679166367 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 12333) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical | |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2021-02-15 |
Last Update Date | 2024-06-18 |