NPI | 1225349772 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR 187062) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 3020) |
363A00000X Physician Assistant (Licence: OK 2156) | |
Enumeration Date | 2010-06-30 |
Last Update Date | 2019-08-01 |