NPI | 1043084254 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9118981) |
Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
Enumeration Date | 2023-11-08 |
Last Update Date | 2024-09-18 |