NPI | 1205204435 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 6390) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 55519) |
363A00000X Physician Assistant (Licence: NY 019134) | |
Enumeration Date | 2015-09-03 |
Last Update Date | 2024-09-24 |