NPI | 1104852094 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10495) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6669778-1206) |
363A00000X Physician Assistant (Licence: AZ 3127) | |
363A00000X Physician Assistant (Licence: OK 1414) | |
363A00000X Physician Assistant (Licence: OR PA223121) | |
363A00000X Physician Assistant (Licence: AK PADA1230) | |
363A00000X Physician Assistant (Licence: CA PA65471) | |
Enumeration Date | 2006-06-23 |
Last Update Date | 2025-05-18 |