NPI | 1114284759 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 012193) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53211) |
Enumeration Date | 2012-04-20 |
Last Update Date | 2025-03-07 |