NPI | 1134780794 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5289) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009837) |
Enumeration Date | 2019-06-25 |
Last Update Date | 2024-07-29 |