NPI | 1902452428 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062247) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0008282) |
Enumeration Date | 2019-08-12 |
Last Update Date | 2023-12-04 |