NPI | 1861068736 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9114600) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2021-06-01 |
Last Update Date | 2023-07-17 |