NPI | 1811248073 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AK 160604) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363AM0700X Physician Assistant, Medical (Licence: AK 160604) | |
363AM0700X Physician Assistant, Medical (Licence: WI 3273-23) | |
Enumeration Date | 2012-09-27 |
Last Update Date | 2023-07-12 |