NPI | 1104454768 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003008A) |
Additional Taxonomies | 363A00000X Physician Assistant |
363A00000X Physician Assistant (Licence: KY TC165) | |
Enumeration Date | 2020-03-30 |
Last Update Date | 2025-03-10 |