NPI | 1821357369 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005682) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22253) |
363A00000X Physician Assistant (Licence: VT 055.0031151) | |
363AS0400X Physician Assistant, Surgical (Licence: CA PA22253) | |
Enumeration Date | 2012-05-03 |
Last Update Date | 2019-03-01 |