NPI | 1285980136 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105053) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12977) |
363A00000X Physician Assistant (Licence: PA MA061623) | |
Enumeration Date | 2012-07-30 |
Last Update Date | 2022-05-24 |