NPI | 1962985655 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-006320) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110-006320) |
363AS0400X Physician Assistant, Surgical (Licence: VA 0110-006320) | |
Enumeration Date | 2018-09-10 |
Last Update Date | 2018-11-30 |