NPI | 1023630738 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK PA4487) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK PA4487) |
Enumeration Date | 2020-05-15 |
Last Update Date | 2024-03-28 |