NPI | 1497036149 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA003411) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056841) |
363A00000X Physician Assistant (Licence: MD C0004545) | |
363AM0700X Physician Assistant, Medical (Licence: PA MA056841) | |
Enumeration Date | 2011-09-07 |
Last Update Date | 2021-01-02 |