NPI | 1356900492 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019009093) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.007591) |
Enumeration Date | 2019-06-12 |
Last Update Date | 2023-11-01 |