NPI | 1720640220 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA210035) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM PA2019-0059) |
Enumeration Date | 2019-07-03 |
Last Update Date | 2023-01-09 |