NPI | 1750860490 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA059967) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA059967) |
Enumeration Date | 2018-08-13 |
Last Update Date | 2018-09-14 |