NPI | 1962779033 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110007649) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA055218) |
Enumeration Date | 2011-11-17 |
Last Update Date | 2022-01-20 |