NPI | 1417108606 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 7138480-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 7138480-1206) |
Enumeration Date | 2008-10-06 |
Last Update Date | 2021-11-17 |