NPI | 1194228684 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2967) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 10732519-1206) |
363A00000X Physician Assistant (Licence: MO 2018013895) | |
Enumeration Date | 2018-03-12 |
Last Update Date | 2022-09-27 |