NPI | 1003392358 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110769) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: NY 020995-1) | |
Enumeration Date | 2018-07-18 |
Last Update Date | 2018-07-18 |