NPI | 1497024574 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL pa9105999) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL pa9105999) |
Enumeration Date | 2011-12-20 |
Last Update Date | 2011-12-20 |