NPI | 1194056192 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3925) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003670) |
Enumeration Date | 2010-01-15 |
Last Update Date | 2010-01-15 |