NPI | 1134675978 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 4880) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-005428) |
Enumeration Date | 2016-08-31 |
Last Update Date | 2025-05-19 |