NPI | 1073383964 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3438) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008877RX) |
Enumeration Date | 2024-01-03 |
Last Update Date | 2024-09-20 |