NPI | 1154953289 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110007641) |
Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2020-02-06 |
Last Update Date | 2022-12-14 |