NPI | 1144603721 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007382) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9108647) |
363A00000X Physician Assistant (Licence: NY 018640-1) | |
Enumeration Date | 2015-07-01 |
Last Update Date | 2015-07-01 |