NPI | 1154787893 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058070) |
Additional Taxonomies | 208D00000X General Practice (Licence: PA OA003888) |
Enumeration Date | 2016-01-11 |
Last Update Date | 2023-10-23 |