NPI | 1063407930 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113677) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical (Licence: WI 608023) | |
Enumeration Date | 2005-09-15 |
Last Update Date | 2024-06-14 |