NPI | 1679969620 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5302) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA5302) |
Enumeration Date | 2015-04-07 |
Last Update Date | 2022-07-25 |