NPI | 1013568856 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9112458) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9112458) |
Enumeration Date | 2019-09-23 |
Last Update Date | 2023-09-15 |