NPI | 1679721245 |
---|---|
Former Name | SARA KATHLEEN VAN WINKLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 51668) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-760) |
Enumeration Date | 2008-09-08 |
Last Update Date | 2019-06-10 |