NPI | 1023543774 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA 54477) |
363A00000X Physician Assistant (Licence: CA 54477) | |
376K00000X Nurse's Aide (Licence: FL 283942) | |
Enumeration Date | 2017-05-01 |
Last Update Date | 2021-08-12 |