NPI | 1013522036 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 0110009313) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PA OA005347) |
363A00000X Physician Assistant (Licence: PA MA061715) | |
Enumeration Date | 2020-09-15 |
Last Update Date | 2024-09-13 |