NPI | 1376272831 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9118290) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA063595) |
Enumeration Date | 2022-06-08 |
Last Update Date | 2024-02-07 |