NPI | 1851964621 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9120431) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13050) |
Enumeration Date | 2021-07-20 |
Last Update Date | 2025-07-15 |