NPI | 1013938992 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031067) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VT 055-0031067) |
363AM0700X Physician Assistant Medical (Licence: CO 2244) | |
Enumeration Date | 2006-07-23 |
Last Update Date | 2021-05-28 |