NPI | 1003491028 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062426) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: NC 001011250) | |
Enumeration Date | 2021-03-11 |
Last Update Date | 2022-09-19 |