NPI | 1336682236 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-112203) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 54024) |
Enumeration Date | 2016-11-24 |
Last Update Date | 2023-11-27 |