NPI | 1255893301 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-1054) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7564) |
Enumeration Date | 2019-04-05 |
Last Update Date | 2021-06-15 |