NPI | 1083265300 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 04612) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4612) |
Enumeration Date | 2019-09-27 |
Last Update Date | 2019-12-05 |