NPI | 1962711796 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 4868) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 4722) |
Enumeration Date | 2010-09-28 |
Last Update Date | 2018-08-28 |