NPI | 1154879351 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR 189587) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA189587) |
Enumeration Date | 2016-09-15 |
Last Update Date | 2025-09-10 |