NPI | 1053742197 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 6858) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA51377) |
Enumeration Date | 2013-11-27 |
Last Update Date | 2022-01-19 |