NPI | 1417506791 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9112531) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-10377) |
Enumeration Date | 2019-09-09 |
Last Update Date | 2022-11-29 |