NPI | 1013498849 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9114435) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 8899) |
Enumeration Date | 2018-08-29 |
Last Update Date | 2022-10-04 |