NPI | 1104014679 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA053973) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2404) |
Enumeration Date | 2007-10-10 |
Last Update Date | 2016-11-04 |