NPI | 1336658459 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005983) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13089) |
363A00000X Physician Assistant (Licence: TN 4024) | |
Enumeration Date | 2017-09-20 |
Last Update Date | 2023-05-13 |