NPI | 1710262860 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 372963-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 372963-1206) |
363A00000X Physician Assistant (Licence: CA PA21756) | |
Enumeration Date | 2011-10-19 |
Last Update Date | 2023-06-21 |