NPI | 1467789560 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054238) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-02104) |
363A00000X Physician Assistant (Licence: AZ 5016) | |
Enumeration Date | 2009-11-10 |
Last Update Date | 2022-11-16 |