NPI | 1376913574 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011717) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.005658) |
363A00000X Physician Assistant (Licence: CO PA.0006705) | |
Enumeration Date | 2015-09-30 |
Last Update Date | 2023-10-06 |