NPI | 1053518340 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 200099) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 200099) |
Enumeration Date | 2007-06-29 |
Last Update Date | 2017-07-12 |