NPI | 1073779609 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 59342) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2639) |
363A00000X Physician Assistant (Licence: CT 002128) | |
Enumeration Date | 2008-08-04 |
Last Update Date | 2021-05-04 |