NPI | 1104475441 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58838) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical (Licence: CO PA.0006514) | |
Enumeration Date | 2019-09-10 |
Last Update Date | 2022-06-06 |