NPI | 1770766842 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA22250) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22250) |
363A00000X Physician Assistant (Licence: SC TL1276) | |
363AS0400X Physician Assistant Surgical (Licence: FL PA9105317) | |
Enumeration Date | 2007-12-12 |
Last Update Date | 2020-02-26 |