NPI | 1881634327 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9102648) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102648) |
363AS0400X Physician Assistant, Surgical (Licence: TX PA02505) | |
Enumeration Date | 2006-06-06 |
Last Update Date | 2014-03-05 |