NPI | 1396391645 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7158) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2019-08-13 |
Last Update Date | 2024-07-31 |