NPI | 1134883788 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009203) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007309RX) |
Enumeration Date | 2021-10-28 |
Last Update Date | 2024-02-28 |