NPI | 1265076756 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 2313) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2900) |
363AM0700X Physician Assistant, Medical (Licence: PA MA061004) | |
Enumeration Date | 2019-10-29 |
Last Update Date | 2022-10-28 |