NPI | 1124611017 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10236) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-02-11 |
Last Update Date | 2023-11-20 |