NPI | 1205079399 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0005415) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363AM0700X Physician Assistant, Medical (Licence: WV 421) | |
Enumeration Date | 2009-04-20 |
Last Update Date | 2019-07-30 |