NPI | 1063631760 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5672) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 003413-1) |
363A00000X Physician Assistant (Licence: TX PA00667) | |
363AM0700X Physician Assistant, Medical (Licence: NM NMPA20070013) | |
Enumeration Date | 2007-04-24 |
Last Update Date | 2022-07-21 |