NPI | 1417579269 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4063) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC962) |
363AM0700X Physician Assistant, Medical (Licence: KY TC962) | |
363AS0400X Physician Assistant, Surgical (Licence: KY TC962) | |
Enumeration Date | 2020-05-15 |
Last Update Date | 2021-10-06 |