NPI | 1447792825 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9113252) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00414900) |
363A00000X Physician Assistant (Licence: NY 020311-1) | |
Enumeration Date | 2016-11-16 |
Last Update Date | 2020-09-24 |