NPI | 1255712899 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA 200812) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 1255712899) |
Enumeration Date | 2015-06-09 |
Last Update Date | 2017-04-25 |