NPI | 1255730842 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004021) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004021) |
363A00000X Physician Assistant (Licence: IL 085005141) | |
363A00000X Physician Assistant (Licence: WI 3423-13) | |
Enumeration Date | 2014-08-19 |
Last Update Date | 2018-10-18 |