NPI | 1104482066 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111554) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12728) |
363A00000X Physician Assistant (Licence: AZ 8424) | |
Enumeration Date | 2019-05-16 |
Last Update Date | 2025-02-07 |